Blood in the Front of the Eye in Cats

Identifying the disease that is causing hyphema is essential in order to save the cat's eyesight. Noting any other symptoms that the cat is displaying is helpful in diagnosing the correct disease.

Blood in the anterior chamber, or front chamber, of the cat's eye is a condition known as hyphema. Hyphema isn't a disease in and of itself but is rather a symptom of a systemic or ophthalmic disease. The condition can range from mild to severe, with mild cases presenting with a light pink color in the fluid in front of the eye. Severe hyphema typically presents with the entire chamber filled with blood, blinding the cat.

Symptoms of hyphema are dependent on the extent that bleeding has occurred and the location from where the bleeding began. 

• Red or pink-colored fluid in the eye between the area of the cornea and the pupil/iris
• Swelling of the cornea
• Corneal lesions
• Cuts or bruises around the eye area
• Eye discharge
• Pain or irritation in the eye, which may cause the cat to squint or close the affected eye
• Blindness or decreased vision in affected eye

There are several diseases or conditions that can cause hyphema to occur. These conditions include:

• Injury or trauma to the eye or head
• Severe uveitis
• Severe retinal detachment or tearing
• Blood clotting disorders
• Hypertension
• Hyperthyroidism
• Chronic glaucoma
• Parasite infection
• Tumor or cancer in the eye
• Retinal dysplasia
• Bleeding of the blood vessels
• Lymphoma

The veterinarian will need the cat's complete health history. It's important to note any other symptoms that the cat is experiencing in order for the vet to correctly identify the disease that is causing the hyphema. The veterinarian will physically examine the cat, noting any signs of trauma, swollen lymph nodes and its blood pressure levels.

An ophthalmic examination will need to be done on the cat's eyes. As part of this exam, a Schirmer tear test, tonometry, pupillary light reflex testing, and fluorescein eye stain to test the cornea will be done. These tests will allow the veterinarian to determine where the bleeding is coming from and may help identify the underlying cause of the hyphema.

A complete blood count, a urinalysis, thyroid serum tests, serum biochemistry tests, blood coagulation tests and chest and abdominal x-rays will also be done. Each of these tests will check the function of other organs in the body and narrow down what disease is causing the bleeding.

If these tests indicate something is wrong with an organ, further tests may need to be done, such as hormonal tests of the adrenal glands, a bone marrow biopsy or an x-ray of the eye orbit and head. These tests are advanced and may need to be done in a hospital.

Medication

Topical corticosteroids as an ointment or eye drops will be prescribed to the cat. Corticosteroids will reduce the inflammation in the anterior chamber and around the eye. The cat will also be prescribed atropine eye drops, which dilate the pupil. Dilating the cat's pupil will help to reduce their pain level and minimize the sticking between the lens and iris. If corticosteroids don't help enough with inflammation, aspirin may be prescribed. Aspirin may increase the risk of future bleeding, however, so it isn't used as the initial treatment. If the cat's intraocular pressure is elevated, glaucoma medications will be prescribed to reduce this pressure and decrease the chance of bleeding.

Surgery

If the intraocular pressure doesn't decrease with the use of medications, glaucoma surgery may be necessary in order to relieve the pressure and save the cat's eyesight. The fluid in the eye will be drained and altered to stop fluid buildup in the eye.

If the hyphema occurred due to a traumatic injury, surgery may also be needed to correct the injury and any accompanying lesions.

Primary Disease Treatment

In order to save the eye, the primary disease must be treated. This may include dietary changes, medications for high blood pressure or hypothyroidism or treatment for a retinal detachment.

The cat's activity must be restricted for at least seven to 10 days. This will allow time for the bleeding to stop and the hyphema to settle away from the cat's front chamber. If a blood clotting disorder is found, the cat will need to stay calm as blood clots can move quickly through the body with activity, causing a heart attack or stroke to occur. If the hyphema has caused vision loss or blindness, it's important to monitor the cat when outdoors. 

Regular follow-up visits with the veterinarian are necessary in order to check for bleeding, test the intraocular pressure and monitor the use of medications. Primary disease treatment will also need to be followed-up with the veterinarian.

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